Chew on this: the risks of smokeless tobacco

In a much-needed measure to keep the consumption of chewing tobacco under check, the Delhi government has extended by a year the ban on the sale, purchase and storage of all forms of chewable tobacco — scented, flavoured and mixed — sold in forms such as gutka, pan masala, khaini and zarda. The extension of the ban has come after the previous notification expired recently. In 2012, a few States, beginning with Madhya Pradesh, Kerala, Bihar, Maharashtra and Rajasthan, banned gutka just months after the notification of the Food Safety and Standards (Prohibition and Restriction on Sales) Regulations, 2011 came into effect. The FSS Act clearly states that “tobacco and nicotine shall not be used as ingredients in any food products”. By the end of 2012, all of 14 States had banned gutka, and in 2013, following the Supreme Court’s direction, gutka was banned in all the States. Besides gutka, 11 States including Delhi have over a period of time banned flavoured chewing tobacco, and three States — Maharashtra, Bihar and Himachal Pradesh — have banned flavoured areca nut too. There is a strong case for all States to ban pan masala as manufacturers have effectively sidestepped the FSS Act by selling chewing tobacco and pan masala in separate sachets. Also, the rampant surrogate advertisement of pan masala products has made a mockery of the ban on gutka. The biggest blow for tobacco control in India, which has banned the advertisement of all tobacco products, came through the amendment of the Cable Television Networks Amendment Rules 2009; in contravention of the World Health Organization Framework Convention on Tobacco Control, the amended Rules allow for the use of the brand name or logo of tobacco products for marketing non-tobacco products.

The International Agency for Research on Cancer, functioning under the WHO, had stated in a 2008 monograph that “areca nut is carcinogenic to humans (Group I).” In India, areca nut is the “second most consumed” carcinogen after tobacco. Also, many of the flavouring agents used in pan masala, a cunning mix of natural products and chemicals, are dangerous substances. So what is preventing the Central government from extending the scope of the amended FSS Act to include areca nut and thereby ban the sale of pan masala in India? After all, the number of smokeless tobacco users in India is alarmingly high at 206 million, as estimated in an August 2012 paper in The Lancet. Unlike in the case of smokers — where less than 10 per cent of cigarette-users are women and a little over the same percentage consumed bidis — about 50 per cent of consumers of smokeless tobacco are women, according to the 2009-2010 Global Adult Tobacco Survey. The number of oral cancer deaths caused by chewing tobacco is alarmingly high. According to the Ministry of Health and Family Welfare, about 100,000 new oral cancer cases are diagnosed every year and nearly 50 per cent of these lead to death within one year of diagnosis. It’s time the government came down heavily on chewing tobacco.